International Clinical Radiotherapy Audit in CCCN- iPAAC Project.

Abstract

Project iPAAC - Innovative Partnership for Action Against Cancer was a project in which 2 centers in Europe were selected for international certification (Lower Silesian Oncology Center and Charité Hospital). We were subjected to general certification under CCCN and organ certification for colorectal and pancreatic cancer. The certification process included the reporting of a set of standards books (general and specific) and quality measures - 35 for colorectal and 21 for pancreatic cancer, an onsite presentation at an audit and a site visit. Radiation therapy was one of 10 table of contents sections. These sections included a description of the structure of the facility including satellite units, equipment and systems integration, the number of patients treated, the team of radiation oncologists, medical physicists, medical technical radiology assistants. In addition, crucial elements were the reporting of waiting time and overrun of total treatment time. We have begun the process of standardizing data entry, acquisition and reporting using the Aria v.15.6 management and verification system with InSightive. The following metrics proved to be key to RT application and quality: QI13 - information on distance to mesorectal fascia, OI26 - quality of TME rectum specimen, QI27 - complete pathology report of colorectal carcinoma, QI2add - neoadjuvant RT/CRT clinical UICC stages II and III. For the calculation of QI, the MSD Data Warehouse system was used. The final audit was performed on the time frame data from 1.01.-31.05.2021. The project lasted from the signing of the tripartite agreement on 7.06.2019 through the pre-audit on 10-11.09.2020 and the audit on 1-2.07.2021 until the certification on 16.09.2021. We have fulfilled mostly set of standard general and specific for colorectal and pancreatic cancer. The SOP for the management of LINAC breakdowns, and radiochemotherapy was detailed. According to the data obtained from the InSightive: the number of patients treated with teleradiotherapy by 31.05.2021 was 2298, and with brachytherapy - 167. The system allowed, with the help of an automated dashboard, to determine the average planning time of 15.3 days and to monitor the overrun of the total treatment time of 0.14% for Wrocław, and 0.31% and 0% for satellite units (in 2020 - 4.5% during Covid pandemics). The percentage results for the reported metrics are as follows: QI13 - 38.65% QI26 - 89.29% QI- 27 - 59.21% QI2add - 80%. In the international audit radiation oncology was summarized in the audit report as very high level and as leading position of CCCN and the chapter of set of standards has been implemented on a wide scale. International audit with set requirements allows to check the resources on personnel, equipment and to complete the missing procedures (SOP). The most objective tools for auditing are quality metrics, and their collection should be automated, allowing for a continuous ongoing quality assurance process.